Do we really need a fully covered self-expanding metal stent for the treatment of difficult common bile duct stones?

We read with interest the article by Hartery et al1 about the use of fully covered self-expanding metal stents (FCSEMSs) in the management of common bile duct (CDB) stones. Approximately 85% to 90% of bile duct stones can be extracted by use of a retrieval basket or balloon catheter after endoscopic sphincterotomy (EST),2 but 10% to 15% of stones may be difficult to remove.3 In those cases. treatment includes endoscopic papillary balloon dilation,4 fragmentation by use of mechanical lithotripsy (ML),5 electrohydraulic lithotripsy,6 extracorporeal lithotripsy, or laser lithotripsy.

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